“Maternal mortality is caused by a variety of health conditions [but] these alone cannot explain the big difference in mortality rate between ethnic groups in the UK and we must look for answers elsewhere. “
Less women die from pregnancy and childbirth today than at any time before thanks to scientific progress and wider access to essential healthcare services. In the UK, the maternal mortality rate is less than 1 in every 10,000 pregnancies, a relatively small number. But when we start looking at differences in mortality rate across the population, and across ethnicity, the picture changes.
5 for 1 – Black mothers die more often
The figures are stark. 7 in 100,000 white women die in childbirth compared to 13 in 100,000 Asian women, 23 in 100,000 mixed ethnicity women, and 38 in 100,000 Black women (according to the 2019 report by MBRRACE-UK and the 2020 report on Black people, racism and human rights). This means that pregnant Black women and new mothers are 5 times more likely to die than their white counterparts and have a higher risk of dying compared to women from any other ethnic background.
Maternal mortality is caused by a variety of health conditions including thrombosis, eclampsia, cardiac and neurological diseases, and maternal suicide, all of which are among the leading causes of maternal death. However, these conditions on their own cannot explain the big difference in mortality rate between ethnic groups in the UK. We must look for answers elsewhere.
The Ethnic Wealth Gap and Health Inequality
The Marmot 2020 Review reported that health in the UK has been declining over the last 10 years, especially for poorer communities including African and Afro-Caribbean groups. Recent data shows that Black people are among the least wealthy in the UK with a median household wealth of £34,000 compared to £314,000 for White British households. The ethnic wealth gap persists because of many factors including difference in employment status, education level, income, household composition, financial debts status, home ownership ( only 20% of Black Africans own a home against 68% for White British and 74% for Indians).
Poverty and low wealth status can considerably increase the risk of poor health and feeds health inequalities. People on the lower end of the wealth ladder often have limited access to nutritious food, higher chronic stress, poorer mental health, substandard housing conditions and higher rate of substance abuse, all of which indirectly increase the risks of maternal mortality for Black women.
Health Care Disparities
The difference in the quality of care provided between population groups is a strong factor driving health care disparities. Many studies highlight how healthcare providers implicit biases affect the way they would provide care to their patients. Bias coming from both personal beliefs but also from their training. Black people have been flagging the striking difference in the care they receive compared to people from other ethnic groups. Black patients, including pregnant women, report being denied medicines, ignored by healthcare staff or neglected (this, this and this are just a few examples).
Racism in medicine is not the only reason behind health care disparities. Age, language, gender, disability status, citizenship status, geographic location, sexual identity and orientation can also lead to discrimination when receiving healthcare. Sometimes even preventing Black women from accessing healthcare all together. For example, in the UK, migrant populations including pregnant women, often do not have access to vital healthcare services for fear of the incredibly large bills they will have to pay (no, the NHS is not free for everyone) or concerns about their immigration status.
Cultural beliefs in Black communities
This is a subject worth discussing that is not often talked about. The narrative of the “strong Black woman” passed down through generations in Black communities can have harmful consequences for Black women. “A lot of older Black women have this belief that our backs don’t break” and that Black women need to endure pain in silence.
As a result, Black healthcare staff (in clinical settings) or older relatives (in communities) may wrongly encourage Black women to not “complain”, dismissing their discomfort or pain. This can contribute to preventing Black women from seeking healthcare, delaying lifesaving care and potentially leading to preventable death.
Solutions – where can we start?
The problem is complex, but too important to dismiss. Millions of Black women’s deaths could be prevented, and it’s urgent that we start acting now. Efforts must come from all sides, government, communities, researchers, medical staff… everyone. And here are 4 suggestions on where we could start:
- We need more data. Always. Quantitative and qualitative data on women affected, their number, their socio-economic background, feedback on the care and support they received before, during and after birth.
- We need to continue our advocacy efforts, backed by evidence and data. Healthcare professionals need better training on their implicit bias, the medical curriculum needs a serious revamp to remove harmful stereotypes and the government must be held accountable for the gaps in its public health strategy.
- We need to recognize that black maternal mortality is just one piece of the puzzle. Black women’s deaths will continue to be higher as long as all other socio-economic markers in black communities remain poor. Solutions need to be cross-dimensional and cross-sectoral looking at how education, job opportunities, financial security and health interact together.
- Finally, we need to raise awareness in communities. Black women need to open the dialogue about how harmful cultural beliefs can be. Encourage women, and men, from all generations, to speak up and share their experiences. Especially on maternal mental health which can be a big taboo.
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